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NPI Code Detail

MEDICARE: DR. LORNA LYANTHIE CONYERS PHD

MEDICARE:  DR. LORNA LYANTHIE CONYERS  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY 19574CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00288631OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356383731
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORNA LYANTHIE CONYERS PHD
Provider Business Mailing Address
First Line : 31532 RAILROAD CANYON RD
Second Line : SUITE 105
City : CANYON LAKE
State : CA
Zip : 92587-9437
Country : US
Telephone Number : 951-246-1055
Fax Number : 951-244-9615
Provider Business Practice Location Address
First Line : 31532 RAILROAD CANYON RD
Second Line : SUITE 105
City : CANYON LAKE
State : CA
Zip : 92587-9437
Country : US
Telephone Number : 951-246-1055
Fax Number : 951-244-9615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 04/28/2014

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